ICUs Neglect UTI Prevention

Action Points

Intensive care units don't have a good track record for implementing policies and procedures to prevent the most frequent healthcare-associated infection.

Hospitals were more likely to have prevention policies aimed at central line-associated bloodstream infection than catheter-associated urinary tract infections (CAUTIs) although CAUTI was the first to be selected by the Centers for Medicare & Medicaid Services for nonreimbursement.

Intensive care units don't have a good track record for implementing policies and procedures to prevent the most frequent healthcare-associated infection, researchers reported.

In a survey-based study of more than 1,600 ICUs, the prevalence of policies aimed at preventing catheter-associated urinary tract infections (CAUTI) was "relatively low," according to Patricia Stone, PhD, of Columbia University School of Nursing in New York City, and colleagues -- ranging from 27% for nurse-initiated urinary catheterization to 68% for portable bladder ultrasound.

Hospitals were more likely to have prevention policies aimed at central line-associated bloodstream infection (CLABSI) -- ranging from 87% for checking lines daily to 97% for applying chlorhexidine at catheter insertion sites -- and ventilator-associated pneumonia (VAP) -- ranging from 69% for providing chlorhexidine mouth care to 91% for raising the head of the bed, Stone and colleagues reported in the February issue of the American Journal of Infection Control.

"Evidence-based practices related to CAUTI prevention measures have not been well implemented," the investigators concluded. "Clearly, more focus on CAUTI is needed."

The findings come from a Web-based survey of hospitals enrolled in the National Healthcare Safety Network, as part of the Prevention of Nosocomial Infections and Cost Effectiveness Refined study.

The goal, Stone and colleagues wrote, was to get a snapshot of infection prevention and control programs in adult ICUs as well as clinician compliance with the processes.

All told, 975 of 3,374 eligible hospitals (a 29% response rate) supplied at least some information on 1,653 ICUs, and there were complete data on the presence of policies in 1,534 ICUs. Half of the departments reported having a physician hospital epidemiologist and the average number of full-time equivalent infection preventionists per 100 beds was 1.2, but certification levels were variable.

The survey asked about such things as reporting mechanisms, staffing levels, prevention policies for the three major healthcare-associated infections, and clinician adherence to the policies.

Overall, Stone and colleagues reported that they found "considerable variation in the organization and structure of infection prevention and control programs across the nation." But just setting policies doesn't ensure they will be followed, they wrote.

"An extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections," they argued. "Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence."

Reported adherence to CLABSI prevention policies ranged from 37% to 71%, adherence to VAP prevention policies ranged from 45% to 55%, and adherence to CAUTI prevention policies ranged from just 6% to 27%.

The study is "the most comprehensive examination" of the issue since the mid-1970s, Stone and colleagues wrote. But they cautioned that the response rate was moderate and the data were self-reported.

The study was supported by the National Institute of Nursing Research and the CDC.

The journal said the investigators did not report any potential conflicts.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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